Hip Joint Osteoarthritis

SYMPTOMS

There is gradual onset of diffuse exercise-induced pain in the groin. The hip joint is usually stiff and more painful in the morning than in the afternoon and rotational movements are most difficult. In severe cases, there is pain during rest. There are periods of better and worse symptoms. Secondary muscular symptoms are very common around the glutei and trochanter regions.

AETIOLOGY

Osteoarthritis is a major problem for the general population and affects most weight-bearing joints. It can be secondary to previous trauma, and this is more common in footballers, ballet dancers and manual workers. Primary osteoarthritis is usually bilateral and hereditary. In the hip, this is a progressive disease affecting the soft tissues as well as the cartilage of the hip joint. For the cartilage, hip osteoarthritis is graded from 0–4 in a radiological score.

CLINICAL FINDINGS

There is usually a restriction in rotation that when tested causes discomfort at the end range. Compare with the other side. Findings depend on the severity. If no structural pathological signs can be found, the problem may be functional, perhaps induced by poor core stability or referred from the back. The patient’s history and a systematic and thorough approach in the clinical examination is crucial for a successful outcome. Tests of core stability, proprioception, muscle strength and balance, flexibility and so on must be thoroughly evaluated.

INVESTIGATIONS

X-ray can help to grade the severity but there could be major cartilage damage before X-ray will show a decreased joint space, sclerosis and osteophytes. Since this is a gradual disorder, many patients seek medical advice in situations where the groin pain is particularly bad.

TREATMENT

There is presently no cure for this condition. However there is a range of symptomatic treatments available, from physiotherapy and exercise modification to NSAID, arthroscopic debridement, excision of loose bodies and various forms of hip joint replacement. A replaced hip joint will last for 15–25 years before a replacement is required.

REFERRALS

These patients are very much helped by being evaluated clinically by Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and physiotherapist in close collaboration.

EXERCISE PRESCRIPTION

With appropriate advice and exercise the time until replacement can be significantly delayed. Cycling, walking,
water exercises and low–impact sports like golf are good alternatives to keep up general fitness.

EVALUATION OF TREATMENT OUTCOMES

Monitoring of clinical symptoms and signs and X-ray.

DIFFERENTIAL DIAGNOSES

It is important to be aware that myriad different conditions can cause these symptoms.

PROGNOSIS

Fair-Poor. Due to the progressive development of symptoms this condition often leads to so much restriction in mobility and pain that a hip joint replacement is required.